Acls Meds

[BruceD]

I always admire people that expend personal time & effort to increase their knowledge base.

I'm not sure what topics you've studied or how deep you want to learn pharmacology, but I suppose it depends on how serious you are about learning and how much time you can devote to it.

You can take a couple of different approaches:
1) Start at the very beginning and build: (Will take a tremendous amount of time). Start with a basic biochemistry book for chemical/receptor reactions/genetic mutations/metabolic disorders, a book of histology & anatomy for receptor locations, and a book of pharmacology for the actions/indications/contraindications/receptor specificities and everything else.

2) You *could* jump in with both feet, grab a book like Katzung's Basic and Clinical Pharmacology (pretty readable really!) and every time you hit something you don't know of, go find the answers. This approach though, you may never feel like you know 'enough'. Especially when (as others have pointed out) the same drug has many different effects depending on location/plasma concentration/route of administration/what other drugs were co-administered/etc and you have to figure out why this is.

3) Lastly, there is always the dreaded pharmacology courses, where you'll get some credit for what you learn and (hopefully) they lead you in a reasonably logical route through the intricacies(sp?).

Pharmacology is like chess, you can learn the basics really fast, but you could spend your entire lifetime learning more about it.


Sorry for the long post, PM me if you want, I have a few decent resources or can maybe point you in a good direction depending on what you want to know.

tc
-B

 

[VentMedic]

Now that is the beginnings of a more solid foundation.

College level A&P, at least two semesters, is a must to learn the different body systems and how they are related. Of course there will be a biology class required to go before those. A chemistry class or two is also a good start to understand chemical reactions. Microbiology, definitely, to understand pathogen processes. College level pathophysiology is highly recommended after that.

Then, the two semesters of basic pharmacology will make more sense.

Yes, there are a lot "Pharmacology Made Easy" books on the market, but again they are the same quick fix mentality that I think you want to avoid. They are good as a second reference if you don't understand something in a college pharmacology class.

 

[pumper12fireman]

While my medic program does not call for pre-reqs of pharmacology, we spent about half a day on the pharmo in the paramedic book...

The next month was spent on power point presentations written by our pharmo/cardiology instructor. It went MUCH more in-depth than our poorly written text. We will obviously cover ACLS meds again at least twice, but familiarization seems to be the key.

 

[skyemt]

thank you for your posts!

good direction, indeed...

to be honest, i have received messages critical of my even asking the questions i've posted ("if you want to be a doctor, go to med school", etc)..

apparently, there are quite a few medics who don't feel this important...

the sheer volume of medical information that pertains to emergency medicine is both awesome and daunting...

and i feel what we are taught in class is just a small speck of information.

i know others have different points of view... but if you could spend several semesters on Pharmacology, but it is covered rather quickly in pre-hospital classes, what does that mean?

wouldn't the care given be better if we knew more?

anyhow, thanks for the direction.

 

[BruceD]

We all know what opinions are like, I'll show ya mine...
----

Honestly, everyone up to and including pharmacists and PhD pharmacologists only learn a 'speck' of what's out there (of course, they know more than anyone about the drugs, just the field is so vast).

I'm a huge fan of personal enrichment through education, however, I have doubts that it would alter quality of care very much, simply because no matter how much you learn, you'll still need to follow your protocols.
Sure, there's personal discretion involved in all forms of care, but altering treatment in the short amount of time the patient is in your care due to subtleties in drug mechanisms is probably not as time efficient/safe for the patient as treatment with diesel.

I do still support you wanting to learn!

It seems that the farther you go in education, the more you find you don't know....

Tc!
-B

 

[VentMedic]

I'm a huge fan of personal enrichment through education, however, I have doubts that it would alter quality of care very much, simply because no matter how much you learn, you'll still need to follow your protocols.
Sure, there's personal discretion involved in all forms of care, but altering treatment in the short amount of time the patient is in your care due to subtleties in drug mechanisms is probably not as time efficient/safe for the patient as treatment with diesel.

-B

Protocols are meant to evolve with the education and skills of the provider. If a profession lacks growth in education, the protocols will not change.

 

[JPINFV]

We all know what opinions are like, I'll show ya mine...

The only people who pull out that tired old line are people who have problems defending the ideas that they hold. I cringe when ever I see/hear someone pull that trite little saying because the problem isn't with discussions or opinions, but with people accepting that not everyone will agree with them 100% of the time.

Honestly, everyone up to and including pharmacists and PhD pharmacologists only learn a 'speck' of what's out there (of course, they know more than anyone about the drugs, just the field is so vast).

I'm a huge fan of personal enrichment through education, however, I have doubts that it would alter quality of care very much, simply because no matter how much you learn, you'll still need to follow your protocols.
Sure, there's personal discretion involved in all forms of care, but altering treatment in the short amount of time the patient is in your care due to subtleties in drug mechanisms is probably not as time efficient/safe for the patient as treatment with diesel.

I do still support you wanting to learn!

It seems that the farther you go in education, the more you find you don't know....

Tc!
-B

So should cardiac transplant patients get atropine? How about picking up a hypokalemic (abnormal labs) patient with pulmonary edema? Lasix doesn't mix well with low potassium. (Loop diuretics stop the Na, K, Cl cotransporter in the thick ascending limb. full disclosure: It was part of the materials for my exam today, so it's fresh).

Also, how does educating oneself limit one's ability to transport? I'm just having a problem with what your saying because the only point I can see is that 'education is worthless since it wouldn't affect your treatment (protocols) and you'll end up transporting anyways.

 

[BruceD]

Ouch...

I apologize, after re-reading my own post, I can see how I could easily be mis-interpreted.

Please read this.

You'll notice, I've said in multiple posts how I always fully support and appreciate ANYONE trying to learn. I seriously hate to hear that he has received messages like 'if you want to be a doctor, go to medical school'. THAT statement makes me cringe because that seems to indicate a disdain for people that want to learn, as if he is 'over-reaching his station in life', when in actuality, education betters the entire ems profession.

Also, how does educating oneself limit one's ability to transport? I'm just having a problem with what your saying because the only point I can see is that 'education is worthless since it wouldn't affect your treatment (protocols) and you'll end up transporting anyways.

I believe that education is the most valuable commodity that anyone can acquire. I was trying (unsuccessfully!) to suggest that perhaps to truly better patient care there needed to be an industry wide push to better ourselves and continue education, because without broad based support, the personal learning that individuals do would remain just that, personal.

How about picking up a hypokalemic (abnormal labs) patient with pulmonary edema?

If I got a patient such as this, it would have to be from a hospital (I don't *think* our trucks have a method for determining potassium levels in patients - I'm not trying to be sarcastic, I really could be wrong) and would therefore receive some treatment directives. Otherwise, we'd have to get far more of a history/physical/labs than hypokalemia with pulmonary edema, including actual potassium levels, ecg, anion gap, renal function, pH, recent illicit/prescription drug use (including etoh), diabetic hx, recent water intake, GI conditions (nausea/vomiting), enema use, dietary status, hereditary conditions, aldosterone/cortisol levels, complete blood chemistry, history of other pulmonary disorders such as asthma & inhaler use, etc etc. I suspect the best treatment for a patient such as this would be to correct potassium levels (and other electrolyte abnormalities). I consider a potassium sparing and/or an osmotic diuretic - but all this is speculation dependent upon the patient's conditions.

So should cardiac transplant patients get atropine?

If I remember correctly, atropine initially and primarily blocks pre-synaptic auto-receptors, then secondarily the post-synaptic muscarinic receptors (for this case, we focus on the vagus nerve as only secondarily at higher doses does it get the M2s on the heart), which is the primary parasympathetic innervation of the heart, antagonizing this in a normal individual allows a higher sympathetic drive..However, a transplanted heart is de-innervated and therefore would not respond in any regular way to an atropine injection.
(this stuff above is just what I *think* I remember, please correct me if I'm wrong - and for heaven's sake, don't use what I say to treat a patient...)

Protocols are meant to evolve with the education and skills of the provider. If a profession lacks growth in education, the protocols will not change.

...I really wanted to get that point across, but in my roundabout way was unable to communicate in my long post the message you stated so succinctly with 2 lines... thank you.

I apologize for my ambiguous post,
never would I discourage learning, not even if the OP was 95 years old and retired.
(I sure hope this post is clearer, even if it is 3am...)
stay safe,
-B

 

[JPINFV]

You'll notice, I've said in multiple posts how I always fully support and appreciate ANYONE trying to learn. I seriously hate to hear that he has received messages like 'if you want to be a doctor, go to medical school'. THAT statement makes me cringe because that seems to indicate a disdain for people that want to learn, as if he is 'over-reaching his station in life', when in actuality, education betters the entire ems profession.

Cool.

I believe that education is the most valuable commodity that anyone can acquire. I was trying (unsuccessfully!) to suggest that perhaps to truly better patient care there needed to be an industry wide push to better ourselves and continue education, because without broad based support, the personal learning that individuals do would remain just that, personal.

I fully agree with that, but even the smallest seed can grow into an oak tree. To get change, there needs to be enough power behind the effort to achieve it. As long as most providers graduate from school thinking "Cool, I've learned 99% of the stuff that I need to know to be a Basic or Medic," then the push for change from the provider level is going to be tough. Especially when the push for education is being opposed by groups such as the International Association of Fire Chiefs.

If I got a patient such as this, it would have to be from a hospital -snip-

You'll also get lab results from nursing home patients some times. I have done my fair share of transports for "abnormal labs" for everything from electrolyte imbalances to elevated BUN.

If I remember correctly, atropine initially and primarily blocks pre-synaptic auto-receptors, then secondarily the post-synaptic muscarinic receptors (for this case, we focus on the vagus nerve as only secondarily at higher doses does it get the M2s on the heart), which is the primary parasympathetic innervation of the heart, antagonizing this in a normal individual allows a higher sympathetic drive..However, a transplanted heart is de-innervated and therefore would not respond in any regular way to an atropine injection.
(this stuff above is just what I *think* I remember, please correct me if I'm wrong - and for heaven's sake, don't use what I say to treat a patient...)

Ding. Correct. Atropine is an antagonist, but since the heart is denerved anyways preganglionic (sympathetic nervous system has ganglionic synapses close to the spinal cord (sympathetic chain ganglion) whereas parasympathetic ganglion are on the target organ), it won't have much of an effect.

I apologize for my ambiguous post,

Nothing to apologize for. Thanks for the clarification.

 

[Ridryder911]

thank you for your posts!

good direction, indeed...

to be honest, i have received messages critical of my even asking the questions i've posted ("if you want to be a doctor, go to med school", etc)..

apparently, there are quite a few medics[/u] who don't feel this important...

the sheer volume of medical information that pertains to emergency medicine is both awesome and daunting...

and i feel what we are taught in class is just a small speck of information.

i know others have different points of view... but if you could spend several semesters on Pharmacology, but it is covered rather quickly in pre-hospital classes, what does that mean?

wouldn't the care given be better if we knew more?

anyhow, thanks for the direction.

Sky, please don't confuse the title of those that would make such asinine statements of what you described as medics! They are even a poor representation of being called an ambulance driver, at least those that acclaim that title do not attempt to misrepresent themselves.

I dare them to publicly post such statements! The difference of being stupid and being ignorant is refusing to learn and increase one's knowledge! Call it like it is! Please, don't glamorous yourself by hiding beneath your own weaknesses, especially to criticize against one that is attempting to broaden their knowledge and education. Such questions is far more in line of medical knowledge than commenting about responding with l/s on their private autos or how to finally pass a test based upon minimal knowledge.

If you don't care to learn about patient care, then I suggest developing another web site for what ever you want to call it. Please, don't refer to it as for being EMS, for that is what EMS is really about and that is it. Nothing else.. period.

R/r 911

 

[pa8109]

Wow,
This has been quite the heated thread. I'll be honest I did not read each post in depth, but I understand you wanted a suggestion for text to learn more about prehospital pharmacology. My paramedic program used Dr. Bryan Bledsoe's text Prehospital Pharmacology. I found it to be a good resource for the basics of prehospital pharmacology. It certainly dosen't replace a college level lecture, but it is a good reference. It all depends on how far you want to take your education. I am a new paramedic and have two years left on a BS in biology and I will continue to educate myself. I have a seen alot of preshospital providers that could care less about the pharmacodynamics of the drugs they give. They give lidocaine for ventricular arrhythmias, atropine to symptomatic bradycardias and asystole, and adenosine to SVT because "the protocol says so" without even knowing how or why the medication works (or doesn't work for that matter). A scary situation to be in. Nothing can replace the understand of how the drugs you give work at a cellular level.

 

[ffemt8978]

Sky, please don't confuse the title of those that would make such asinine statements of what you described as medics! They are even a poor representation of being called an ambulance driver, at least those that acclaim that title do not attempt to misrepresent themselves.

I dare them to publicly post such

R/r 911

I don't think that would be such a good idea...<_<

 

[bonedog]

"Nothing can replace the understand of how the drugs you give work at a cellular level."

Very true. Along with knowing the drug CI's by route,this is how one should approach the subject, in order to "do no harm".

I try not to get too in depth, start with understanding the various anion/cation interactions, cellular mediators and how the different muscle types function. As most of the pharmacology is theory, no sense getting too indepth.

IF you want to get in deep, try explaining your understanding of your favourite antiarrythmic to a pharm D, and see where it goes......:blush: